AIDS

The Politics of Survival

Nancy Krieger, Glen Margo

• Publisher: Routledge
• Year: 2020
• eBook ISBN:
  9781351868631
• Topic: Medicine
• Subtopic: Public Health, Administration & Care

In one short decade, the politics of AIDS has become the politics of survival. In a world whose social order is changing before our eyes, AIDS insistently brings new meaning to the age-old question of what it is we must do to survive-as individuals, as families, as communities, as nations, as members of an interdependent world. This book brings together a collection of articles that frankly discuss what it will take to stop the AIDS epidemic and deal with the devastation it has already wrought.

SECTION IV

Solidarity and AIDS

Introduction

Nancy Krieger

If you had AIDS, what would you do? Take a moment. Think about it. Answer this question.

If your partner or your lover or your spouse had AIDS, what would you do? If your mother or father, your brother or sister, your aunt or uncle, or your child, had AIDS, what would you do? If your best friend or your other friends or your neighbors had AIDS, what would you do? And if you were dying of AIDS—or if all these people in your life were dying of AIDS, one by one, or many all at once—what would you do?

Perhaps more than any other disease in recent history, AIDS has taught a cruel and crucial lesson: the constraints on our response are as deep as our denial, as entrenched as the inequities that permeate our society, as circumscribed as our knowledge, and as unlimited as our compassion and our commitment to human rights. Elaborating on these themes, the three chapters in Section IV consider three widely divergent yet intimately connected topics: AIDS in Cuba, AIDS in Brazil, and global AIDS prevention in the 1990s. Together, they caution that if we persist in treating AIDS as a problem only of “others,” no country will be spared the social and economic devastation that promises to be the cost of our contempt and our folly. Solidarity is not an option; it is a necessity. Without conscious recognition of the worldwide relationship between health, human rights, and social inequalities, our attempts to abate the spread of AIDS—and to ease the suffering that follows in its wake—most surely will fall short of our goals.

AIDS IN CUBA

Chapter 8, “Human Immunodeficiency Virus in Cuba: The Public Health Response of a Third World Country,” provides a thoughtful, clear, and thorough description of the epidemiology of AIDS in Cuba and the country’s evolving efforts to develop a comprehensive program for the control of its human immunodeficiency virus (HIV) epidemic. Throughout, the three authors—Sarah Santana, Lily Faas, and Karen Wald—carefully delineate the encouraging as well as troubling aspects of Cuba’s multifaceted campaign. An example of what a poor and socialist country can achieve in terms of providing health care for all, Cuba has guaranteed this right to all persons infected with HIV. At the same time, however, the Cuban government’s initial strategy to control AIDS relied upon regressive measures: persons infected by HIV were isolated from the rest of Cuban society. This was done despite the knowledge that AIDS is not a casually transmitted disease. By seeking to understand what led Cuban health officials to adopt this approach—and why they are now moving away from quarantine and toward integrating HIV-infected persons back into their families, workplaces, and communities—the authors offer invaluable insights into the ways in which ideological convictions shape not only health policy but also the overall relationship between a government and its citizens.

According to Santana and colleagues, Cuba’s AIDS program has five key components: (a) protecting the blood supply, (b) mass screening of the general population and “high-risk groups” (including persons who have worked abroad or had sexual contact with foreigners), (c) mass education, (d) isolation of all persons infected by HIV (ill or not) and their removal to a sanitorium (with those interned guaranteed health care, full salaries, and also social support for their families), and (e) clinical research to develop effective treatments. While Cuban health officials stress that quarantine was adopted as only a preliminary strategy to take advantage of the “epidemiologic opportunity” afforded by the initially low numbers of HIV-infected persons in Cuba, the evidence offered by the authors suggests more fundamental issues may be at stake: the Cuban belief in individual sacrifice for the good of the nation, combined with the Ministry of Health’s apparent distrust of the Cuban population’s willingness or ability to adopt safer sex practices (despite the fact that condom sales have soared).

Most telling of all, however, is the observation that while the Cuban government now emphasizes personal responsibility for curbing the spread of AIDS, the quarantine policy has led most citizens to believe that the state is taking care of everything. Moreover, despite Cuba’s renown for its creative mass campaigns, educational efforts have been further undermined by the government’s hedged and often paternalistic approach to AIDS. As documented by the authors, flaws include: (a) excessive reliance on AIDS educational materials produced abroad; (b) underutilization of the country’s cultural and artistic talent, as well as expert sex educators, in the design and implementation of the AIDS education campaign; (c) increasing emphasis on physicians, rather than the mass media, as the primary source of AIDS education; and (d) the omission of AIDS as a topic for study group discussions within the many mass organizations to which most Cubans belong. In the end, Santana and colleagues note that despite all these defects, Cuba has managed to provide health care to and prevent the impoverishment of people infected by HIV, feats that many wealthier nations have not even begun to achieve. The question we are left with is whether Cuba’s accomplishments had to be accompanied by the coercion of quarantine. The evolving answer fortunately seems to be “no.”

AIDS IN BRAZIL

If Cuba represents one example of a Third World country’s response to AIDS, in which government programs have distorted the relationship between individual and collective responsibility for AIDS prevention, then according to Herbert Daniel, one of Brazil’s leading AIDS activists, Brazil is the nightmare we all hope to escape. In Chapter 9, “We Are All People Living with AIDS: Myths and Realities of AIDS in Brazil,” Daniel offers a searing indictment of the insufficient and outrageous response of the Brazilian government, media, and society to a rapidly escalating epidemic of already overwhelming proportions. In a land where extremes of wealth and poverty surpass imagination, AIDS has been downgraded to a “second class” epidemic, denied even the desultory treatment accorded the “great epidemics of history that,” as Daniel pointedly remind us, “have never been eliminated.”

Daniel’s essential thesis is that while AIDS was anticipated in Brazil through voyeuristic and homophobic reporting of the epidemic’s spread within the United States’ gay community, no serious efforts were ever undertaken to prevent AIDS from taking root. Instead, the threat was minimized, as if Brazil were somehow immune to this “foreign” disorder. When AIDS did surface in 1983, the official response, according to Daniel, was to adopt an abstract, inappropriate, and ideological “Western” model, in which only stigmatized “others” and “minorities” were at risk of HIV infection. Using this model, and the logic that the exception proves the rule, Brazilian health authorities subsequently downplayed the significance of the sale of contaminated blood in HIV transmission, and likewise ignored the rising rates of AIDS among Brazil’s one unarguable majority group: the poor. With wonderfully mordant humor, Daniel illustrates the consequences of the health officials’ strenuous efforts to force the “facts” of AIDS to fit the false model’s predictions. One striking example details their pitiful attempts to reduce the richly varied sexual relations in Brazilian society to the anemic and limited Anglo categories of “heterosexual,” “bisexual,” and “homosexual.”

Beyond alerting us to the perils of preconceptions, Daniel’s chapter also stands as an extremely powerful statement by a self-identified person with AIDS regarding the need to affirm life and to embrace solidarity as the principle upon which our response to the epidemic must be based. To Daniel, the context is clear: we all are people living with AIDS precisely because we live in this age of AIDS. Using the metaphor of Highland, Virginia—where, in a protest against establishing a home for abandoned AIDS babies, one woman wrote: “AIDS IS A WORLD PROBLEM, SO WHY BRING IT TO HIGHLAND?”—Daniel illustrates how Highland is not only present in every Brazilian town where persons with AIDS have been vilified, discriminated against, and denied necessary treatment, but is also present within all of us whenever we try to assert that AIDS is someone else’s problem. In this time of crisis, Daniel argues, it is sheer folly to discriminate against persons infected by HIV and to obstruct their participation in efforts to curtail the epidemic’s spread. According to Daniel, the necessary response to AIDS i...

Table of contents

• Cover
• Title Page
• Copyright Page
• Acknowledgments
• Table of Contents
• Introduction, Nancy Krieger
• Section I: The Politics of Aids
• Section II: Aids: Community Survival in the United States
• Section III: Women and Aids
• Section IV: Solidarity and Aids
• Section V: The Histories of Aids
• Contributors